Provider Demographics
NPI:1568607778
Name:KIM, SEI ROK (LAC)
Entity Type:Individual
Prefix:MR
First Name:SEI
Middle Name:ROK
Last Name:KIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13201 SAN PABLO AV.
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3952
Mailing Address - Country:US
Mailing Address - Phone:510-292-5881
Mailing Address - Fax:510-620-9735
Practice Address - Street 1:13201 SAN PABLO AV.
Practice Address - Street 2:SUITE 302
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3952
Practice Address - Country:US
Practice Address - Phone:510-292-5881
Practice Address - Fax:510-620-9735
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8110171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist